Free Settlement Disbursal Sheet

This Settlement Disbursal Sheet is a detailed statement of a net payment to a client once an attorney has settled a case. This Settlement Disbursal Sheet contains the amount of total settlement, attorney fees, costs for medical records, copies, police reports, other miscellaneous payments made by attorney and the total net payment to the client.

Disclaimer:This was not drafted by an attorney & should not be used as a legal document.


Total Settlement Amount $ ___________________________
Attorney Fees $ ____________________________
Medical Records: $ _________________________
Police Reports: $ _________________________
Legal Fees: $ _________________________
Copies: $ _________________________
Telephone/Fax: $ _________________________
Miscellaneous: $ _________________________
Total Costs $ ____________________________
Other Payments $ ____________________________
Net Payment to Client: $ ____________________________
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